Perimenopause library · Symptoms
Hot flashes and night sweats last longer than older advice often said
Vasomotor symptoms — hot flashes and night sweats — are the symptom cluster most people have been told to expect, and the one older clinic advice often treated as brief.
SWAN followed thousands of women at seven US sites. In the 2015 analysis of frequent vasomotor symptoms (six or more days in the prior two weeks), median total duration was 7.4 years. Among those with an observed final menstrual period, frequent symptoms lasted a median 4.5 years after that period.
When the symptoms started mattered. Onset in premenopause or early perimenopause predicted the longest course (median more than 11.8 years total; 9.4 years after the final period). Onset after menopause was shortest (median 3.4 years).
Race and ethnicity gaps were large in the same paper: African American 10.1 years; Hispanic 8.9; White 6.5; Chinese 5.4; Japanese 4.8. Longer duration also tracked with younger age at first symptoms, lower education, perceived stress, symptom sensitivity, and depression or anxiety at first report. Those are associations in a cohort, not a verdict about any one person.
A 2016 SWAN analysis found four trajectories over a median 15.4 years of follow-up: consistently low (about 27%), persistently high (about 26%), early onset before the final period then falling (about 18%), and late onset just after the final period (about 29%).
Guidelines have historically understated how long frequent symptoms can last. The evidence-based counsel is simply this: frequent vasomotor symptoms can last more than seven years. How long they will last for you is not something a tracker can say.
What this article cannot tell you
- Which SWAN trajectory you are on.
- How many more years your hot flashes will last.
Questions worth taking to a clinician
- How bothersome are these flashes for me, not just how frequent they are?
- If they have already lasted several years, what options are still on the table?
Sources
- Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, Hess R, Joffe H, Kravitz HM, Tepper PG, Thurston RC. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine. 2015. doi:10.1001/jamainternmed.2014.8063
- Tepper PG, Brooks MM, Randolph JF, Crawford SL, El Khoudary SR, Gold EB, Lasley BL, Jones B, Joffe H, Hess R, Avis NE, Harlow S, McConnell DS, Bromberger JT, Zheng H, Ruppert K, Thurston RC. Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause. 2016.